<正>胆囊结石合并胆总管结石(common bile ductstones,CBDS)是胆道外科的常见病、多发病,文献报道因胆囊结石行胆囊切除术的患者,3%～14.7%合并CBDS[1]。随着腹腔镜胆囊切除术

目的观察异甘草酸镁对大鼠外科型急性肝功能衰竭的保护作用。方法将30只SD大鼠随机分为异甘草酸镁组、对照组和假手术组,除假手术组外其余两组大鼠接受85%肝切除手术。于术前3d至术后48h,每天分别给予假手术组和对照组大鼠腹腔内注射生理盐水1ml/100g,异甘草酸镁组大鼠腹腔内注射异甘草酸镁100μg/100g。术后观察各组大鼠氨基转氨酶指标的变化及肝组织的病理学改变。另取20只SD大鼠,同法构建异甘草酸镁组和对照组,观察术后两组大鼠生存期的差异。结果对照组大鼠术后血清丙氨酸转氨酶(ALT)和天冬氨酸氨基转移酶(AST)急剧升高,显著高于假手术组(P<0.01),异甘草酸镁组大鼠术后ALT和AST的升高要明显低于对照组(P<0.01),两组大鼠的生存期无显著差异(P>0.05)。病理学检查显示异甘草酸镁组大鼠肝细胞损伤明显轻于对照组。结论腹腔内注射异甘草酸镁[100μg·(100g)-1·d-1]对大鼠外科型急性肝功能衰竭有显著地保护作用,但尚不能有效地延长大鼠的生存期。

Objective To investigate the effect of administration of magnesium isoglycyrrhizinate combined with splenectomy on rats with subtotal hepatectomy. Methods 50 SD rats were randomly divided into five groups:85% hepatectomy control group (group A), 85% hepatectomy with splenectomy group (group B),treated with magnesium isoglycyrrhizinate group (group C), treated with magnesium isoglycyrrhizinate combined with splenectomy group (group D) and the sham operation group(group E). The rats in group C and D were intraperitoneally injected with magnesium isoglycyrrhizinate (100 μg/ml)1 ml/100 g,while the other groups injected with normal saline. The changes of plasma ALT and AST, portal venous pressure were recorded and the liver pathological examination were screened post-operation. Results The ALT and AST and portal venous pressure in treatment groups were significantly lower than those in 85% hepatectomy group at 24 h and 48 h post-operation(P0.05). But there were no such differences between group A and group C(P0.05). Conclusions Administration of magnesium isoglycyrrhizinate combined with splenectomy might prevent the acute hepatic failure induced by 85% hepatectomy on rat,and its possible mechanism might relate to the decreasing portal vein pressure and alleviating the residual hepatic cell injury.

AIM: To evaluate the safety and efficacy of intraoperative 125I seed implantation for advanced esophageal squamous cell carcinoma (ESCC). METHODS: Eca-109 cells cultured in vitro were divided into four groups: cells untreated (control group) and those treated with low- (0.2 mCi), medium- (0.4 mCi) and high-dose 125I seeds (0.8 mCi). After 125I seed implantation, the cloning efficiency, apoptotic index and cell cycle of Eca-109 cells were detected. For animal experiment, Eca-109 cells were inoculated subcutaneously in the right femoribus internus of nude mice. ESCC-bearing mice were then divided into five groups: mice untreated (control group), mice undergoing spurious operation (prick into the tumor without implanting seeds), and those treated with low- (0.2 mCi), medium- (0.4 mCi) and high-dose 125I seeds (0.8 mCi). Tumor volume was then evaluated. For clinical trial, 298 patients with phase II to III ESCC were randomized into two groups: patients undergoing both surgery and intraoperative 125I seed implantation and those undergoing surgery alone. Postoperative complications were observed. The shortand long-term efficacy of 125I seed implantation was followed up. RESULTS: The cloning efficiency of cells of the three treatment groups was significantly lower than that of control cells (all P < 0.05). The cell cloning efficiency was also significantly lower in cells treated with high- and medium-dose 125I seeds than in those treated with low-dose 125I seeds (both P < 0.01) though no significant difference was noted between the high- and medium-dose groups (P > 0.05). The apoptotic index (AI) of cells of the three treatment groups was significantly higher than that of control cells (all P < 0.01). The apoptotic index (AI) was also significantly higher in cells treated with highand medium-dose 125I seeds than in those treated with low-dose 125I seeds (both P < 0.01) though no significant difference was noted between the high- and medium-dose groups (P > 0.05). The percentage of G2/M phase cells increased with the enhancement of the 125I seed activity (P < 0.01). The reduced rates of tumor growth in mice treated with 125I seeds were statistically higher than that in control mice. There was no statistical difference in the reduced rate of tumor growth between control mice and mice undergoing spurious operation (P > 0.05) as well as between mice treated with high- and medium-dose 125I seeds. In patients undergoing 125I seed implantation, no displacement or loss of seeds occurred. The local recurrence rate was significantly lower (14.9% vs 38.7%, P < 0.05) and the rate of complete response (CR) plus partial response (PR) was significantly higher (78.8% vs 30.3%, P < 0.05) in patients undergoing intraoperative 125I seed implantation than in those undergoing surgery alone. There were no statistical differences in the incidence of complications and the 1-year survival rate (both P > 0.05) between the two groups of patients. However, the 3-, 5-, and 7-year survival rates were statistically higher in patients undergoing surgery alone than in those undergoing intraoperative 125I seed implantation (64% vs 52%, 42.7% vs 34.5% and 25.1% vs 12.6%, all P < 0.05). CONCLUSION: Intraoperative 125I seed implantation brachytherapy can reduce local recurrence and improve survival in patients with ESCC and therefore represents a safe, effective and simple approach for ESCC.

Objective To study the change in Th1/Th2 cytokines and its relationship with ALT,HBV DNA and HBeAg conversion in chronic hepatitis B (CHB) patients treated with telbivudine.Methods 64 HBeAg-positive CHB patients treated with telbivudine were included in the study.Th1cytokines (IL-2,IL-12) and Th2 cytokines (IL-4,IL-10) were measured by ELISA before treatment and at the 24th week after treatment.ALT and HBV DNA were evaluated at the same time.Results 86% of the patients showed normal ALT and 53% had undetectable serum HBVDNA level after 24 weeks of treatment.The HBeAg conversion rate was 23.4% at the 52nd week of treatment.The level of Th1 cytokines in the treatment group was higher and Th2 cytokines was lower than that of the control group.There was a significant difference between pre-treatment and post-treatment cytokine levels (p0.05).Serum HBV DNA and ALT levels were decreased dramatically with the antiviral therapy.Conclusion There is a significant correlation between serum cytokine level,ALT and HBV DNA in CHB patients treated with telbivudine.The balance between Th1/Th2 cytokines may contribute towards normal ALT,undetectable HBV DNA and HBeAg serum conversion.

1 病案摘要 患者女,55岁,农民,因进食梗噎感1年余于2006年7月3日入院.既往有胃溃疡史12年.入院查体无明显异常,鼻咽部及其它部位未发现肿瘤.6月27日电子胃镜示:距门齿26～28cm处可见2个卵圆形隆起病灶,大小0.7cm×0.6cm及2cm×1.5cm,有蒂样组织,表面糜烂坏死不明显,组织弹性存在,食管下端未检及明显异常改变,HP(++).

<正>1临床资料患者,女性,55岁,因进食梗噎1年余于2006年7月3日入院。既往有胃溃疡史12年。入院查体无明显异常,鼻咽部及其它部位未发现肿瘤。入